Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
BARRIER ADHES 3X5IN PROC PK BIORESORB MEMBRANE SEPRAFILM SOD HYALURONATE
Low
$0
Average
$1.5k
Median
$976
High
$32.5k
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
1013 hospitals; the 90th percentile is 9.2× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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1,318 hospital rates
iThe hospitals that file a UnitedHealthcare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Texas Health Presbyterian Hospital Dallas Dallas, TX percent of total billed charges · outpatientfrom % of charges | 3 | $2.2k | $3.0k | $2.6k | 87% | 35–350 | $65 – $10.2k |
| 2 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 3 | $772 | $1.4k | $1.5k | 107% | 18–180 | $507 – $5.9k |
| 3 | Advocate Lutheran General Hospital Park Ridge, IL percent of total billed charges · outpatientfrom % of charges | 2 | $515 | $679 | $444 | 65% | 14 | $267 – $1.8k |
| 4 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 4 | $695 | $1.1k | $1.2k | 107% | 9–90 | $276 – $5.9k |
| 5 | Mishawaka Medical Center Mishawaka, IN facility · percent of total billed charges · bothfrom % of charges | 2 | $478 | $831 | $1.0k | 122% | 9–90 | $196 – $4.5k |
| 6 | Mount Carmel St Ann's Lewis Center, OH facility · percent of total billed charges · bothfrom % of charges | 2 | $781 | $1.5k | $1.6k | 112% | 9–90 | $491 – $6.2k |
| 7 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · percent of total billed charges · bothfrom % of charges | 1 | $975 | $1.6k | $1.5k | 90% | 9–90 | $613 – $5.7k |
| 8 | Saint Francis Hospital and Medical Center Hartford, CT facility · percent of total billed charges · bothfrom % of charges | 2 | $361 | $686 | $772 | 113% | 9–90 | $241 – $2.8k |
| 9 | Samaritan Hospital Troy, NY facility · percent of total billed charges · bothfrom % of charges | 3 | $532 | $1.0k | $1.3k | 129% | 9–90 | $207 – $7.0k |
| 10 | St Joseph Mercy Ann Arbor Ypsilanti, MI facility · percent of total billed charges · bothfrom % of charges | 2 | $974 | $1.2k | $696 | 60% | 9–90 | $458 – $3.0k |
| 11 | METHODIST LEBONHEUR GERMANTOWN HOSP GERMANTOWN, TN percent of total billed charges · bothfrom % of charges | 7 | $337 | $321 | $98 | 31% | 7–70 | $121 – $498 |
| 12 | University of Colorado Hospital Authority Aurora, CO percent of total billed charges · outpatientfrom % of charges | 3 | $1.0k | $1.2k | $611 | 51% | 6–60 | $510 – $2.4k |
| 13 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MICHIGAN CITY CITY, IN percent of total billed charges · bothfrom % of charges | 2 | $605 | $523 | $217 | 41% | 5–50 | $227 – $736 |
| 14 | BAPTIST HEALTHCARE SYSTEM INC Corbin, KY percent of total billed charges · outpatientfrom % of charges | 2 | $1.3k | $3.0k | $5.1k | 173% | 4–40 | $155 – $16.3k |
| 15 | BAPTIST HEALTHCARE SYSTEM INC Lexington, KY percent of total billed charges · outpatientfrom % of charges | 3 | $1.3k | $2.3k | $3.1k | 136% | 4–40 | $174 – $12.1k |
| 16 | Good Samaritan Hospital Puyallup, WA other · outpatient | 1 | $1.9k | $1.9k | — | — | 4–40 | $1.9k – $1.9k |
| 17 | Hendrick Medical Center Abilene, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $12.9k | $11.6k | $6.7k | 58% | 4–40 | $1.9k – $18.5k |
| 18 | Hendrick Medical Center Abilene, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $12.9k | $11.6k | $6.7k | 58% | 4–40 | $1.9k – $18.5k |
| 19 | Massachusetts General Hospital Boston, MA percent of total billed charges · outpatientfrom % of charges | 1 | $885 | $1.3k | $808 | 62% | 4–40 | $721 – $2.7k |
| 20 | Mercy Hospital Oklahoma City Inc City, OK facility · percent of total billed charges · outpatientfrom % of charges | 2 | $361 | $412 | $97 | 23% | 4–40 | $347 – $578 |
| 21 | Sanford Fargo Medical Center Fargo, ND percent of total billed charges · outpatientfrom % of charges | 2 | $1.6k | $1.6k | $459 | 28% | 4–40 | $1.1k – $2.6k |
| 22 | St Luke's Regional Medical Center, LTD Mountain Home, ID percent of total billed charges · bothfrom % of charges | 1 | $1.4k | $2.1k | $1.7k | 82% | 4–40 | $617 – $4.8k |
| 23 | Tacoma General Allenmore Hospital Bremerton, WA other · outpatient | 1 | $850 | $850 | — | — | 4–40 | $850 – $850 |
| 24 | UKIAH ADVENTIST HOSPITAL Ukiah, CA percent of total billed charges · outpatientfrom % of charges | 2 | $2.7k | $2.7k | $127 | 5% | 4–40 | $2.5k – $2.9k |
| 25 | Advocate Illinois Masonic Medical Center Chicago, IL percent of total billed charges · outpatientfrom % of charges | 2 | $1.3k | $1.5k | $834 | 55% | 3–30 | $582 – $3.4k |
← Payers reporting HCPCS C1765 · Snapshot 20261111T120946Z-9134e7f7